MEDICAL STORYTELLING

On a very basic level, storytelling can help people involved with the medical profession by heightening their awareness of the importance of listening, honing their skills as a receiver of information, or story.  Every patient that walks into a doctor’s office has a story about why they are there.  Some of it they will tell you and some you may need to coax out of them.  The patient may not even be aware of an important piece of their story.  Listening deeply to your patient, or helping them to draw out their story, will not only help you to diagnose and treat, but it will establish a trusting relationship with those in your care.  Dr. Rachel Naomi Remen, who lectures and teaches extensively on the power of heart-centered, story-centered medicine, talks about “listening generously” and “the power of presence”.

This relationship starts when a person enters the reception area!  How the receptionist (and everyone after them) relates to your patients – from the attitude they project to recognizing distress in people - will affect their experience and how they perceive their medical care.  Storytelling, then, can help in two additional ways:

* Becoming more aware of what we communicate (consciously or unconsciously) as well as what our patients communicate through vocal intonation and body language as well as words. While storytelling is a form of communication, my workshop also engages people in specific exercises that highlight these skills.

* Developing empathy for your patients.  By entering into the storytelling process you must understand – and take on! - the characters’ lives and their inner, emotional world…. to “walk in someone else’s shoes”.  This is an essential skill for affective communication necessary to understanding your patient’s story and, consequently, helping in establishing the doctor-patient relationship.  Sue Bonis, Nursing Educator, calls it a “knowing”.

Palliative care and hospice work provides a special place for storytelling and story listening: helping patients and family members understand the situation at hand, making sure you understand the patients needs and desires and helping the patient share and pass on their life stories.  The more you hear and tell stories (in many genres), the more attuned you become to finding the thread of the story for the patient and for each family member….each of whom will have their own story of who the dying person is to them, to their family, to their community.  An African story called “The Cow Tale Switch” speaks to the fact that as long as we keep the stories of a deceased person alive, they will always be with us.

James Hallenbeck, Author of Palliative Care Perspectives, speaks to the skills involved with end of life situations: interviewing skills, empathy, drawing out the answers with questions, understanding who the characters are who are in the story.  He states these observations: “Physicians (and other clinicians) talk too much and do not listen enough; Physicians tend to focus exclusively on the cognitive (thinking) aspects of communication and ignore affective (emotional) aspects; Physicians tend to force their agendas over patient and family agendas.”  He goes on to say that, while doctors are scientists, they are also human.  And families want a combination of medically based knowledge along with a person they can relate to.

And then there are short teaching tales that provide a metaphoric template to help people understand or cope with a situation…. a powerful and poignant story can bring home a point or to make someone think without preaching.  People understand information better within the narrative format, which provides a context within which to understand facts and meaning.

Lastly, as with any teaching situation, those in nursing education and medical training can wisely use stories – both traditional tales as well as those from your own experiences in the field – to help understanding and break down the barriers between teacher and student. 

Sue Bonis, Nursing Educator sums it up well:

“I tell my students stories about how we move beyond the tasks and connect to the person…..to look at the personal patterns of the patient rather than only the pathio-physiological to intervene pharmaceutically.  It’s the technical tasks that bring us to the patient that allow us to engage with the human being.”

In my former life as an EMT, it was commonplace – in fact part of the workplace culture - to refer to the days work as ‘I had a fractured tibia and a COPD’.  The person didn’t seem to come into the equation at all!!  Storytelling is one avenue to remind us that that it is human being that we are treating.  I hope you can join us on the journey!

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